Organization
LAKE COUNTY FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EILEEN SRAJ (OFFICE MANAGER)
(440) 352-4880
Entity
Organization
Contact information
Practice address
9500 MENTOR AVENUE, SUITE 100, MENTOR, OH 44060
(440) 352-4880
(440) 352-3629
Mailing address
PO BOX 75358, CLEVELAND, OH 44101-2199
(440) 352-4880
(440) 352-3629
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0588430
—
OH
Enumeration date
03/07/2007
Last updated
07/28/2008
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